Outline

Background and aim: Guidelines for osteoarthritis patients (OAP) focus on drug treatment of pain and inflammation. As there is a high risk for side-effects and interactions – especially in the vulnerable population of the elderly – evidence based recommendations for first choice drugs and co-medication are given.

Aim of the analysis was to investigate drug utilization in patients with clinically relevant osteoarthritis with regard to national treatment guidelines.

Material and method: 2,221 persons out of a registration office sample of 7828 citizens of the city of Herne (North Rhine-Westphalia) aged 40 years or older filled in a postal questionnaire in the year 2005 and gave information about symptoms, pain localisation and intensity, comorbidity and drug utilization. Information about drug utilization comprised prescribed drugs, self medication and aspects of patient compliance. Mentioned drug brands were identified regarding their active ingredient(s) and classified by the Anatomical Therapeutic Chemical Classification System (ATC-System). Survey participants who marked „Gelenk-VerschleiÃ (Arthrose)“ as the known cause of their joint pain where identified as OAP.

Results: 860 out of 2221 survey participants were identified as OAP (38.7%; 95%CI: 36.7–40.7%). 65.5% of the OAP (95%CI: 62.3–68.7%) were analgetic drug users in the last 12 months to reduce their pain complaints – but only 42.1% (95%CI: 38.8–45.4%) of the OAP had a guideline adequate treatment of symptoms with analgetic/anti-inflammatory drugs (Paracetamol, NSAIDs or COX 2 inhibitors) in their present medication. Among 333 OAP treated with an NSAID 56.2% (95%CI: 50.8–61.5%) received at least one additional active ingredient resulting in an increased risk for interactions. At least 41% of the OAP had an increased risk for gastrointestinal bleeding (GIT-risk: age>70 years, anamnestic ulcer or gastric bleeding, corticosteroid or anticoagulant treatment). A proportion of nearly 34% (33.9%, 95%CI: 29.0–38.8%) of this high-risk group was treated with NSAIDs. But only every fifth patient of the high-risk group with NSAID utilization (19.8%, 95%CI: 12.6–27.0%) received the recommended gastric protection (Proton Pump Inhibitor or Misoprostol).

Conclusions: Relevant deficits in the drug treatment of OAP can be assumed from these results. Both symptom therapy and co-medication and consideration of potential interactions are concerned.